Before you’re involved in an out-of-network medical bill dispute that would be covered by the state’s new baseball-style arbitration law, it’s best to know what could be in store.
The Texas Medical Association already offers a concise overview of Senate Bill 1264, and the Texas Department of Insurance (TDI) website has more resources on the law, which took effect Jan. 1.
On its website and at a meeting TMA staff attended in late December, TDI laid out further details on how the law will be implemented, including how the arbitration process will work.
Among the information TDI relayed at the Dec. 30 meeting:
- Physicians who pursue arbitration, also known as independent dispute resolution (IDR), must obtain a login on the state’s IDR portal. The portal includes a form with questions to fill out and will explain which state-regulated health plans are subject to SB 1264.
- Although the law allows for physicians to bundle multiple claims with a total disputed amount of up to $5,000, each claim must be entered individually into the portal system.
- TDI plans to post bios (including CV) and fees of its listed arbitrators on its website by mid-January.
- If the parties don’t agree on an arbitrator within 30 days after arbitration is requested, TDI will provide a list of five names from its list of arbitrators. From there, each party has “two strikes,” meaning they each can veto two of the names. TDI will select the arbitrator from the remaining names.
A link to the IDR portal, and more information, including webinars on how to use the IDR portal and on the benchmarking database that will be used for the arbitration program, can be found on the TDI website.
TDI also has set up an IDR helpline for use during weekday business hours at (855) 839-2427, and also offers help via email at IDR@tdi.texas.gov.
Last Updated On
January 28, 2020